A popular entertainer collapsed during a performance and was brought to our community hospital. During his stay, rumors flew about his alleged drug and alcohol abuse. Reporters buttonholed every staff member they could find for information. When it was all over, three nurses were fired for violating patient confidentiality by accessing the patient's medical records without a need-to-know.

Hospital administrators determined that two physicians had done the same, but punished them only with "official censure." How fair is that? If administrators can't fire physicians who aren't technically hospital employees, shouldn't they have at least revoked their privileges?- E.I., FLA.

Ethically and legally, your hospital is obligated to follow its policies and procedures for disciplining employees, including nurses, and apparently it did so. Policies and procedures that govern physician behavior at a hospital are determined by the medical staff, not by hospital administration. These are two separate policy structures and two separate disciplinary systems, so disciplinary actions, even for the same infraction, could be quite different. While that may not seem fair and equal, it's the condition under which nurses accepted employment at the hospital.

During new employee orientation, the hospital is obligated to inform newly hired nurses about policies regarding confidentiality and the consequences for violating those policies. The hospital isn't obligated to inform nurses about medical staff policies.

That said, one organization-the federal government, as represented by legislation known to us all as the Health Insurance Portability and Accountability Act, or HIPAA-treats physicians and nurses equally under the law. That's the one hospital administrators should worry about any time patient confidentiality is violated!! After this dramatic incident, I hope administrators, your chief nursing officer, and the director of the medical staff will carefully revisit policies and education about patient rights for all hospital staff in light of HIPAA privacy rules.